Dr. Pam Nordstrom at the Human Resources, Skills and Social Development and the Status of Persons with Disabilities Committee

Mr. Chair and honourable members of the committee, thank you for the opportunity to tell you what we've observed regarding assessments of internationally educated nurses.

I'm here as director of the School of Nursing at Mount Royal University in Calgary. One of my responsibilities is to work with internationally educated nurses. I do want to clarify, though, that I'm not here representing the Alberta nursing regulators.

Over the past six years we've taken some good directions based on the recommendations that were described in a document called “Navigating to Become a Nurse in Canada”. However, we're clearly experiencing a nursing shortage, and our successful initiatives are being taxed by the number of people accessing our services.

Although our initiatives have been very successful in where we've come from in the last six years, we are unable to track and to speak to outcomes.

I'm going to provide you with my recommendations first and then proceed to explain why I've identified these points and how they link to the funnel that's on top of that slide.

We need to support data-sharing to improve understanding of IEN recruitment and retention patterns; we need policies to support stakeholder collaboration to improve flow through the funnel, which I'm about to explain; we need sustainable recruitment plans of international nurses; we need to build databanks of assessment tools and incorporate intelligent technologies; and we need to measure outcomes along the funnel.

Mount Royal has had considerable experience in pioneering initiatives for internationally educated nurses over the past decade. I won't take time to describe each of our studies, but I've presented the ones we've received funding for under the slide “IEN initiatives at MRU”. Our learnings from these initiatives are the basis for my comments and recommendations.

What have we learned?

We've chosen to use a funnel to describe the recruitment and retention flow, at least from our perspective. The reason we want to use a funnel was that it showed that a much larger number of IENs start the process than actually end up working. However, the shape of the funnel isn't perfect, in that it doesn't show proportions, if we used the analogy “leaks”, of where the leaks might be in our funnel.

The different stages in the funnel are essentially sequential. IENs, who either refer themselves or are brought through the recruitment process through a formal agency recruitment, contact the professional regulator, and if the professional regulator is unable to determine, by paper documentation, that they have the competencies to enter practice in Canada as a nurse, they'll refer them to Mount Royal, where we do an assessment of their skills and competencies. I'll speak to that in just a moment.

A report on their assessment is referred to the regulator, who then determines if they need a bridging program. And once they've completed the bridging program they move on to write the national exam and then move into the workplace.

At each phase of that funnel, IENs may choose to continue or they may to choose to step out and come back later. And certainly the push and pull factors in the context they live in are at play in terms of immigration or family needs, but we haven't identified those in the funnel specifically.

Our experience over the past five years certainly indicates that the countries of origin impact the number of people who are coming through that funnel. Currently, 75% of all internationally educated nurses who apply to our regulator, the College and Association of Registered Nurses of Alberta, are referred to us for further assessment. Just over half of those who are asked to contact us actually do. And once they've contacted us, just over half of those proceed.

Approximately 200 IENs come through each year, and we've assessed over 1,200 IENs in the past five years. Of those who are required to go through the assessment process, 70% are required to do remediation. That may sound high, but remember, the IENs who are good to go, so to speak, who have met the requirements, don't come to our assessment centre.

We've also learned that our assessment strategies must be comprehensive to reflect the complex nature of our practice. So we have a series of tests. Certainly language and communication are a challenge, and the regulator requires that all English language requirements be done prior to their assessments. Partnerships with regulators, government, and employers are essential for this process to work.

The purpose of an IEN assessment is twofold: to assess IEN competencies that aren't evident in their paper documentation to the regulator, and to provide IENs an opportunity to demonstrate their capacity for practice as a Canadian nurse. We use a constellation of tools and it takes one to four days depending on the nature of the assessments required. We've benefited greatly from our provincial government grants that fund centres in Edmonton and Calgary. The average cost, based on our studies, is about $1,000 per assessment. IENs need anywhere from one to four assessments, so it's an average of $4,500 per IEN. But the candidate does not have to bear those costs. It's important to know that we report to the regulator what our assessments are and the regulator makes a decision on what bridging is needed.

We have a program called “Bridge to Canadian nursing”. Once the assessments have been done and the IEN is needed or requires some bridging, she can apply to the program. We have eight courses they can take, but they take only what they need, and they bear the cost of this tuition. We've noticed that the average course-taking has gone up over the past couple of years, but that also reflects the countries of origin from which recruitment's been occurring. Of IENs who engage in this part of the process, 95% complete their studies.

We are seeing many IENs, but because of the limited information that flows through the funnel, we can't speak definitively about the yield to the workforce or outcomes. We know there are leaks and losses within that funnel. We don't know the scope and magnitude of those losses, because of the limitations on information-sharing across the system of stakeholders, so we're unable to measure our flow-through in concrete outcomes and costs. We know IENs sometimes get lost in that funnel, and we don't know the reasons for this, although we have many anecdotal pieces of information.

In summary, I go back to the recommendations I presented at the beginning. Assessment and bridging courses are critical tools for access to the RN profession. But we need the ability to track so we can use a unique identifier that started with IENs at the beginning of the funnel and followed them all the way through. This would help us to get accurate information and a strong sense of outcomes. It would help us to understand why the IENs are leaving the system.

We need coordinated, regular engagement by all stakeholders and at all levels of the government to coordinate policy development that makes sense to those who are implementing it and actually improves the situation for IENs. We need sustainable recruitment plans so that stakeholders and resources are aligned and sufficiently nimble to be able to manage the expansion and compressions of recruitment.

The processes we've developed for assessment, at least in the western provinces and in collaboration with Nova Scotia, are serving IENs and regulators well, at least better than they were when the “Navigating to Become a Nurse in Canada” document was written in 2005. But we need to invest in databases of assessment tools and use intelligent technologies that make these tools accessible to IENs and the assessors while still maintaining security.